How Are Acne and Depression Related?

There Is a Correlation Between Acne and Depression, but No Clear Cause-and-effect Is Known

How Are Acne and Depression Related?

Article Summary

Acne has negative effects on mental well-being, and clearing up acne lightens the load of everyday living. That much is known. But what about depression? Can acne cause depression? And for that matter, can depression lead to bodily changes that can cause acne?

The answer we have so far from the research is that acne and depression often occur together, which means they are "correlated," but there is not a clear cause-and-effect relationship. This means that acne does not necessarily cause depression, or vice versa. However, there is evidence that each condition can affect the other: acne may worsen depression, and depression may worsen acne. 

Many people who get acne experience a reduction in self-esteem. Acne can make people feel a range of emotions, including frustration, sadness, and anger. This is well known. However, in this article we will look at the relationship between, particularly, acne and depression, which is a mood disorder that comes with feelings of sadness and a general loss of interest that persists over time.

Let’s take a deep dive and look at all of the research we have on whether acne causes depression and, conversely, whether depression causes acne.

We Found Depression Coexisting in Many Patients with Acne


Acne and Depression are Correlated

Acne and depression often occur together, and most of the research literature agrees that there is an association between them. However, the available evidence indicates that there is no clear cause-and-effect relationship between these two conditions, meaning that neither condition causes the other.1-6

When two conditions co-occur, but we cannot determine such a relationship, we say that there is a correlation between them. This simply means that there is an association, but that it does not imply causality. As a 2010 article in the Journal of Cosmetic Dermatology stated,

Journal of Cosmetic Dermatology

“While our data cannot determine a direct cause and effect relationship, we found depression coexisting in many patients with acne.”4

Let's start by examining how depression often shows up in people with acne.

Acne vulgaris is associated with significant psychological disability


Depression Sometimes Accompanies Acne

Although acne is a physical disease, it can result in significant psychological distress and is correlated with depression. This is backed up by several studies showing that acne may cause or increase depression and may potentially even lead to suicidal thoughts.1,7,8

Expand to read details of studies 

Lipids in Health and Disease Journal

A 2008 article in the journal, Lipids in Health and Disease, noted,“Acne vulgaris is a common skin condition, one that is associated with significant psychological disability. The psychological impairments in acne include higher rates of depression, anxiety, anger and suicidal thoughts.1

British Journal of Dermatology

Similarly, the Canadian Dermatology Association stated that acne is correlated with multiple psychological effects, including depression. According to their website, “A Canadian study of nearly 500 patients with acne published in the British Journal of Dermatology found that even having mild acne can bring on feelings of low self-esteem, depression and suicidal thoughts.”7

Clinics in Dermatology Journal

Lastly, a 2013 article in Clinics in Dermatology noted, The literature consistently points to an increased suicide risk in patients with…acne, with higher risk in patients in whom the [acne] is associated with clinically significant emotional distress, changes in body image, difficulties in close relationships, and impaired daily activities.”8

Acne and Depression Are Correlated


Acne Sometimes Accompanies Depression

On the flip side of the coin, people who are depressed often have acne.

Nobody likes having acne. However, depression can worsen these negative feelings, as was indicated by two separate studies.2,6

Expand to read details of studies 

Journal of Cutaneous Medicine and Surgery

A 2004 article in the Journal of Cutaneous Medicine and Surgery stated,“Although depression and anxiety do not cause acne, the quality-of-life impact of acne may be magnified in those who are either anxious or depressed.”6In other words, pre-existing depression may worsen the emotional distress associated with acne.

Journal of Drugs in Dermatology

A 2010 article in the Journal of Drugs in Dermatology noted, “The emotional impact of acne is influenced by numerous factors including…psychosocial factors [such as depression].”2

People often report that stress, including depression, triggers their acne flares. If depression caused the acne flare, then we would expect that treating the depression would also treat the acne. However, this is not the case. In fact, some acne patients complain that their acne becomes worse when being treated for depression, and acne is listed as a possible side effect of some antidepressants, including Zoloft® and Wellbutrin®.9

Therefore, from the research we currently have available, even though depression can worsen the psychological impact of acne, it is not known to cause acne.
 

What Does the Research Say About the Relationship Between Acne and Depression?

Many studies indicate a correlation. The majority of the research literature indicates a correlation between acne and depression, though different studies reached different conclusions about the nature of that correlation.Some studies indicate that people with acne report more depression.10,11,12

Expand to read details of studies 

 

The Improvement of Acne Appears to Be Associated with Decreased Depression
Some studies indicate that treating acne appears to improve the depression.13,14

Expand to read details of studies 

International Journal of Dermatology

A 1990 study in the International Journal of Dermatology evaluated psychiatric health in patients with mild to moderate acne. This study found that not only is acne associated with depression, but treating it appears to improve the depression. The authors concluded, “The improvement of acne appears to be associated with decreased depression.”13

Dermatology Online Journal

A 2011 literature review in Dermatology Online Journal assessed the psychological effects of acne in teenagers. This study found that depression occurred more often in teens with acne and that treating it appeared to improve the depression. The authors concluded, “Depression and other psychological disorders are more prevalent in acne patients and acne treatment may improve symptoms of these disorders.”14

One study indicates that people with depression are more likely to have acne:

Dermatology and Psychosomatics Journal

A 2002 study in Dermatology and Psychosomatics found that participants who reported depressive symptoms are more likely to develop acne.15

One study indicates that more severe acne correlates with more severe depression:

Journal of Investigative Dermatology

A 2011 study in the Journal of Investigative Dermatology evaluated the relationship between acne severity and suicidal thoughts in teenagers. This study found that teens with more acne reported suicidal thoughts about twice as often as teens with little or no acne.16

One study indicates that the severity of acne is not related to the severity of depression:

The Journal of the European Academy of Dermatology and Venereology (JEADV)

A 2004 study in the Journal of the European Academy of Dermatology and Venereology found that depression was significantly more common in acne patients than in those without acne but that the presence of depression was unrelated to the severity of acne. In other words, the presence of acne raised the risk of depression, but whether the acne was mild or severe made no difference.17

One study indicates a reciprocal (two-way) relationship between acne and depression:

Cell Biochemistry and Biophysics

A 2015 study in Cell Biochemistry and Biophysics investigated the link between acne and psychological wellbeing. This study found a reciprocal relationship between acne and psychological distress: greater anxiety or depression was associated with more acne, and acne was associated with greater levels of anxiety or depression.18

Some studies show no correlation between acne and depression. While most studies found a correlation between acne and depression, a few studies observed the opposite.19,20,21,22

Expand to read details of studies 

Dermatology Journal

A 2001 study in Dermatology assessed the effect of acne treatment on psychological issues, such as depression. This study found that acne treatment and the resulting reduction in acne did not improve emotional health.19

The Journal of the European Academy of Dermatology and Venereology (JEADV)

A 2008 study in the Journal of the European Academy of Dermatology and Venereology investigated the relationship between acne, depressive symptoms, and suicidal thoughts. This study found no correlation between acne and depression or suicidal thoughts.20

Indian Journal of Dermatology

A 2010 study in the Indian Journal of Dermatology found no significant difference in the prevalence of depression in acne patients when compared to a control group.21

Journal of Investigative Dermatology

A 2015 study in the Journal of Investigative Dermatology found that acne patients were not at increased risk for depression or suicidal thoughts.22

A word of caution: We cannot draw conclusions from these studies. Taken all together, the research to date indicates not only that there is a correlation between acne and depression but that this relationship is reciprocal. This means that acne can affect depression, and depression can impact acne. However, it is important to note that the majority of studies conducted thus far concerning the relationship between acne and depression pose significant problems that limit our ability to draw conclusions.

Most studies used minimally rigorous study-designs, such as case reports and case-control surveys, rather than rigorous designs, such as randomized controlled trials. The data in case reports and in case-control surveys can be suspect, partly because:

  • Most studies relied on self-reported data, such as surveys and questionnaires, rather than on a professional’s diagnosis to determine the presence and severity of both acne and depression.
  • Many studies included only a small number of participants, did not include control groups to compare with the acne groups, and did not take into account other factors, such as acne severity and personal or family history of depression.4

How Are Acne and Depression Related?
Because of these methodological problems, we cannot draw conclusions based on the existing research about the nature of the relationship between acne and depression. We can conclude only that a correlation between the two conditions appears to exist.

However, on a real world level, clearing up acne is helpful to one's mental state, and we don't need studies to tell us that. 

 
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References:

  1. Rubin, M. G., Kim, K. & Logan, A. C. Acne vulgaris, mental health and omega-3 fatty acids: a report of cases. Lipids Health Dis. 7, 36 (2008).
  2. Fried, R. & Friedman, A. Psychosocial sequelae related to acne: looking beyond the physical. J. Drugs Dermatol. 9, s50–2 (2010).
  3. Gordon-Elliott, J. S. & Muskin, P. R. Managing the patient with psychiatric issues in dermatologic practice. Clin. Dermatol. 31, 3–10 (2013).
  4. Uhlenhake, E., Yentzer, B. A. & Feldman, S. R. Acne vulgaris and depression: a retrospective examination. J. Cosmet. Dermatol. 9, 59–63 (2010).
  5. Kilkenny, M. et al. Acne in Victorian adolescents: associations with age, gender, puberty and psychiatric symptoms. J. Paediatr. Child Health 33, 430–3 (1997).
  6. Thomas, D. R. Psychosocial effects of acne. J. Cutan. Med. Surg. 8 Suppl 4, 3–5 (2004).
  7. Canadian Dermatology Association. Psychological Effects of Acne
  8. Picardi, A., Lega, I. & Tarolla, E. Suicide risk in skin disorders. Clin. Dermatol. 31, 47–56 (2013). 
  9. Lewis, C. A. Enteroimmunology: A Guide to the Prevention and Treatment of Chronic Inflammatory Disease. (CreateSpace Independent Publishing Platform, 2014). 
  10. Tan, J. K. Psychosocial impact of acne vulgaris: evaluating the evidence. Skin Therapy Lett. 9, 1–3, 9 (2004). 
  11. Kubota, Y. et al. Community-based epidemiological study of psychosocial effects of acne in Japanese adolescents. J. Dermatol. 37, 617–622 (2010). 
  12. Uhlenhake, E., Yentzer, B. A. & Feldman, S. R. Acne vulgaris and depression: a retrospective examination. J. Cosmet. Dermatol. 9, 59–63 (2010). 
  13. Gupta, M. A., Gupta, A. K., Schork, N. J., Ellis, C. N. & Voorhees, J. J. Psychiatric aspects of the treatment of mild to moderate facial acne. Some preliminary observations. Int. J. Dermatol. 29, 719–721 (1990). 
  14. Dunn, L. K., O'Neill, J. L. & Feldman, S. R. Acne in adolescents: quality of life, self-esteem, mood, and psychological disorders. Dermatol. Online J 17, 1 (2011). 
  15. Polenghi, M. M., Zizak, S. & Molinari, E. Emotions and Acne. Dermatol. Psychosom. 1, 20–25 (2002). 
  16. Halvorsen, J. A. et al. Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: a population-based study. J. Invest. Dermatol. 131, 363–370 (2011). 
  17. Yazici, K. et al. Disease-specific quality of life is associated with anxiety and depression in patients with acne. J. Eur. Acad. Dermatol. Venereol. 18, 435–439 (2004). 
  18. Wen, L., Jiang, G., Zhang, X., Lai, R. & Wen, X. Relationship between acne and psychological burden evaluated by ASLEC and HADS surveys in high school and college students from central China. Cell Biochem. Biophys. 71, 1083–1088 (2015). 
  19. Mulder, M. M. et al. Psychosocial impact of acne vulgaris. evaluation of the relation between a change in clinical acne severity and psychosocial state. Dermatology 203, 124–130 (2001). 
  20. Rehn, L. M., Meririnne, E., Hook-Nikanne, J., Isometsa, E. & Henriksson, M. Depressive symptoms, suicidal ideation and acne: a study of male Finnish conscripts. J. Eur. Acad. Dermatol. Venereol. 22, 561–567 (2008).
  21. Golchai, J. et al. Comparison of anxiety and depression in patients with acne vulgaris and healthy individuals. Indian J. Dermatol. 55, 352–354 (2010).
  22. Dalgard, F. J. et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J. Invest. Dermatol. 135, 984–991 (2015).
See More References

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